• Past 30 Day statistics, According to the 2012 National Survey on Drug Use and Health, • 6.5% of the population over 12 reported heavy drinking • 9.2% reported illicit drug use • The majority of people who use recreationally will not need treatment • Addiction is characterized by compulsive craving for the substance and using that substance despite negative consequences • Cravings and compulsive behavior are caused in large part as a consequence of substance use or addictive behaviors on the brain causing • Emotional • Cognitive • Physical • Behavioral changes Definition of Addiction • Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. • Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations reflected in pathological pursuit of a reward and/or relief by a substance. • Without treatment and/or engagement, addiction is progressive and can result in disability or premature death. (ASAM 2011, NIDA 2007) Characteristics of Chronic Disease • Disrupts normal functioning • Have serious, harmful consequences • Are preventable and treatable • Can last a lifetime • May be fatal if untreated Addiction—A description, not a Diagnosis • Addiction is a description, not a diagnostic term. • Addiction erodes a person’s self-control and ability to make sound decisions • The DSM V has 2 diagnostic categories • Substance abuse • Substance dependence (The medical definition of addiction) • Dependence is always characterized by dependence and withdrawal Factors Influencing Addiction • No single factor is causative • General Categories • Biological/genetic makeup • Gender • Ethnicity • Developmental stage/early use • Social environment • Proximal (neighborhood, school/work, friends, family) • Cultural/Media/Availability • Method of administration Factors Influencing Addiction • Genetic Factors • 40-60 % of a person’s vulnerability is genetic. • Expression of these genes is influenced by: • Effects of the environment • Reactions/effects of addictive behaviors • Genetic predisposition to mental health issues (self-medication) • Social Environment & Peer and School • Access • Social learning of acceptability and use patterns • Exposure to peers/family who engage in criminal behavior • Academic/work failure • Poor social skills / unstable relationships

Factors Influencing Addiction • Developmental/Early Use • The earlier the initiation, the greater the likelihood it progresses to addiction • Addictive behaviors have a stronger impact on the developing brain (esp. the prefrontal cortex) • Indicative of a set of vulnerabilities/triggers • Genetics • Mental Illness • Unstable family relationships • Exposure to abuse

Theories of Causation • Moral Model • Addiction is the result of defects of character • Rejects any biological basis • Focuses on individual choices and values retraining • Disease Model • Addiction is an illness resulting from an impairment of neurochemical or behavioral processes • Presented by Jellinek leading the APA and AMA adopting the disease model • Addiction is a primary disease and not caused by anything else Theories of Causation • Genetic Model • Individuals have a genetic predisposition • Difficult to separate social causes from family and genetic causes • Cultural Model • Cultural attitudes and availability impact which addictions people develop • Blended Model • Addiction develops in each individual as a result of a unique set of factors Continuum of Addiction • Social – risky/problematic –abuse –dependence • Many individuals never progress beyond risky consumption • Recovery from addiction is a multidimensional process which differs between people and changes over time. • Risky/problematic users have some amount of control and can learn methods to cope. • Dependent users seem to have no control over their use. • One and done • Progression over time

Reinforcers Within the Cycle of Addiction • Reinforcers • Add to the benefits of use • Become less important as the drug causes neurochemical imbalances • Psychological • Enhance the rewards of other experiences (Sex, social) • Boosts self-confidence • Alleviates stress and dysphoria • Reduces pain • Coping skills fail to develop or atrophy as addictive behaviors substitute • Confidence in dealing with life on life’s terms diminishes • Avoided problems worsen and increase anxiety Reinforcers Within the Cycle of Addiction • Social Aspects • Social lubricant • Social bonding • Biological Aspects • Impact the reward/pleasure centers in the mesolimbic system • Brain begins producing less dopamine or letting less dopamine through the system • Person becomes dependent on surges of dopamine to feel pleasure • Sobriety produces feelings of dysphoria until the brain can rebalance itself • Self-medication of mental health disorders

What is Recovery • Improvement of health and wellness in order to live a self-directed life and strive to reach one’s full potential. • Recovery involves the interaction between • Race/ethnicity • Gender • Sexual orientation • Family history • Developmental stage • Environment • Culture • Individual strengths, values and needs What is Recovery • Recovery • Begins with accepting there is a problem and that • Help is needed to overcome it • Responsibility for recovery from the problem and associated issues lies with the person • Is individualized and lifelong • Abstinence is often the goal • Harm reduction can be considered as an alternate goal • Relapse occurs when a person • Is unaware of the process of recovery • Unable to accomplish the tasks required at each stage of recovery • Lacks adequate access to treatment/support

Goals of the Initial Interview • Establish trust and develop rapport • Be empathetic • Convey warmth and respect • Explore client strengths and skills • Facilitate client’s understanding of rationale, purpose and procedures of the screening and assessment process • Explore the client’s problems and expectations regarding treatment and recovery • Determine whether a further assessment is needed Screening • The process by which the counselor, client and SOs review the current situation, symptoms and collateral information to determine the probability of a problem • Used by all types of human service personnel to determine eligibility and appropriateness of services and needed referrals • Screening helps determine the immediacy of need • Must be a transparent process • Requires informed consent • Identification of early warning signs helps provide early intervention services and/or resources Screening • Screening is the first opportunity to engage the client in the therapeutic relationship and treatment process • Sometimes, based on observation or other circumstances people may be referred directly for assessment. • The client’s internal motivation is the primary reason for engaging in treatment. • Internal motivation may be fleeting, so rapid engagement is vital. Screening • Successful screening should be • Brief • Conducted in a variety of settings by a range of professionals on persons deemed to be at risk • A collaboration among a multidisciplinary team • Sensitive to racial, cultural, socioeconomic and gender related concerns • Developed from information gathered from multiple sources when possible

Mental Health Disorders Common in Co-D • Post Traumatic Stress Disorder • Exposure to an stressor which involved the threat of death or significant injury to self or another in which there was significant helplessness and horror. • Can occur when learning about a trauma which occurred to someone else, especially a significant other • Eating Disorders • Person is intensely afraid of gaining weight and exhibits a disturbance in the perception of the shape of size of his or her body. • Types • Anorexia • Bulimia • Binge Eating Disorder

Mental Health Disorders Common in Co-D • Schizophrenia and Psychotic Disorders • Psychosis is the term for a severely incapacitated mental and emotional state involving thinking, perception and emotional control • Hallucinations –False perceptions • Delusions –False beliefs and a deterioration in thinking, judgement or self-control • Schizophrenia is the most common psychotic disorder • NOT multiple personality • Symptoms (often begin to develop before the first psychotic episode) • Hallucinations or delusions • Disorganized speech • Disorganized or catatonic behavior • Deficits in functioning

Diagnosis and the DSM • The Diagnostic and Statistical Manual is created to • facilitate communication between and within professions regarding mental health and substance use disorders • Improve interrater reliability regarding diagnosis • Improve sharing of information about client presentation and needs ICD-10 • International Classification of Disease is used for diagnosis (like the DSM)

Diagnosis of Substance Use Disorders • The DSM V recognizes 10 separate classes of drugs • Alcohol • Inhalants • Opioids • Sedatives • Hypnotics/Barbiturates • Anxiolytics • Stimulants • Caffeine • Tobacco • Cannabis • Hallucinogens • Other/Unknown substances SUD Diagnosis • Although how each types of drug acts in the brain differs, they all activate the brain’s reward system • Two groups of substance disorders • Substance use • Substance induced SUD Diagnosis • Diagnosis • Using in larger amounts or for longer than intended • Wanting to cut down or stop but failing • Spending increased time getting, using or recovering from use • Cravings and urges • Neglecting work, school, family, social obligations because of use • Continue to use even when it causes problems in relationships • Giving up important social, occupational, recreational activities because of use • Using in risky situations • Continuing to use despite knowing that it is making a physical or psychological problem worse • Tolerance • Withdrawal

Diagnosis of Substance Use Disorders • SUD severity is dependent on how many symptoms are present • 2-3 symptoms = Mild • 4-5 = Moderate • More than 5 severe • Qualifiers • In early remission • In sustained remission • On maintenance therapy • In a controlled environment

Recovery Management • Treatment does not need to be voluntary, but success depends on personal engagement • Full recovery often comes from episodic, nonlinear treatment • Previous treatment and relapse is not indicative of poor prognosis • Relapse is viewed as evidence of the severity of the condition rather than a cause for discharge • Recovery management is a time-sustained, recovery focused collaboration between consumers and service providers with the goal of stabilizing and managing the ebb and flow of co-occurring disorders until full recovery is achieved or self-management is possible. Recovery Management • Spans 3 phases • Prerecovery identification and engagement • Recovery initiation and stabilization • Recovery maintenance Referral • Dual-diagnosis or co-occurring disorders indicates the presence of both mental health and addiction issues. • People with co-occurring issues often experience more severe emotional, social and physical problems than someone with only one issue • Medical, Mental health and Addictive disorders all influence each other • Use and withdrawal can both cause mood, social and physical conditions • Continuum: Disorders vary in terms of… • Severity • Chronicity • Disability/degree of impairment in functioning

Drugs of Abuse • Prescription Drugs • Opiates • Ranks #2 behind marijuana as most abused drug • 60% of people who abuse it got it free from friends/relatives • Treat • Pain • Depression • Depressants (Benzos / Barbiturates) • Anxiety • Sleep disorders • Stimulants • Narcolepsy • ADHD • Obesity Drugs of Abuse • Prescription and OTC (i.e. DXM, pseudoephederine) drugs can be abused by: • Taking medication prescribed for someone else • Taking drugs in a higher amount or via a different method than intended • Taking drugs for a different purpose than intended • Combining drugs • Same class • Different class Withdrawal from Drugs of Abuse • Sustained use of addictive substances of behaviors causes reversible adaptations within the body • Reduce the effects of the drug (tolerance, dependence) • Withdrawal • Euphoria producing drugs act on the nucleus accumbens (pleasure center) • Alcohol and benzodiazepine withdrawal can be life threatening Post Acute Withdrawal Syndrome Intake • Intake • Is the process of enrolling a client in a specific course of treatment • A series of activities designed to organize information about the client and their significant others • Ensures eligibility • Completes basic data collection • Identifies barriers and assets • Establishes a treatment approach • Primarily administrative in nature • Needs to be standardized in nature • It is an extension of the screening and assessment process • Can be used to engage the client in treatment and enhance motivation for change Orientation • Can be conducted in individual, family or group settings • Completed after the intake • Describes specific aspects of treatment • Schedule • Goals • Rules and responsibilities • Hours of service • Medication • Drug testing • Treatment costs • Client rights Client Rights • Florida Statute 381.026 • Individual dignity • Confidentiality • Right to nondiscriminatory services • Standard (Age, race, gender, sexual orientation, disability) • Prior service departures • Number of relapses • Level of psychotropics • Ability to pay (public agencies) Client Rights • Quality services • Communication • With informed consent communication may be limited • Personal effects • unless for to do so would infringe upon the right of another patient or is medically or programmatically contraindicated for documented medical, safety, or programmatic reasons • May be temporarily held by the agency but must be returned at the end of treatment • Minors to be educated • Counsel (involuntary proceedings) • Habeus corpus (full evidence of what is being alleged) Client Rights • (Florida Specific) • A patient has the right to a prompt and reasonable response to a question or request. • A patient receiving care in a health care facility or in a provider’s office has the right to bring any person of his or her choosing to the patient-accessible areas of the health care facility or provider’s office to accompany the patient while the patient is receiving inpatient or outpatient treatment or is consulting with his or her health care provider, unless doing so would risk the safety or health of the patient, other patients, or staff of the facility • A patient has the right to refuse any treatment • A patient has the right to express grievances to a health care provider, a health care facility, or the appropriate state licensing agency regarding alleged violations of patients’ rights. Client Rights • (Florida Specific) • A patient has the right to know the name, function, and qualifications of each health care provider who is providing medical services to the patient. A patient may request such information from his or her responsible provider or the health care facility in which he or she is receiving medical services. • A patient in a health care facility has the right to know what patient support services are available in the facility. • A patient has the right to be given by his or her health care provider information concerning diagnosis, planned course of treatment, alternatives, risks, and prognosis, unless it is medically inadvisable or impossible to give this information to the patient • A health care provider or health care facility shall respect a patient’s legal right to own or possess a firearm and should refrain from unnecessarily harassing a patient about firearm ownership during an examination.

Treatment Plan • Is a contract between the client, counselor and treatment team, each being responsible for its development and implementation • The clinician should recognize that • Treatment occurs in different settings over time • Much of the recovery process occurs outside of or immediately following treatment • Treatment is often divided into phases • Engagement • Stabilization • Primary treatment • Continuing care

Treatment Planning • Plots out a roadmap for the treatment process • Treatment plans are completed once • A diagnosis is made • Level of care is determined • Client is admitted to the program • Level of care is determined based on • Diagnosis • Client’s strengths and assets

Treatment Planning • Treatment plans address all biopsychosocial needs • Establish what changes are expected through achievable goals • Clarifies what interventions and counseling methods will be used to help the patient achieve those goals • Sets the measures that will be used to gauge success • Incorporates the clients strengths, needs, abilities and preferences • Referrals are made to other agencies as needed • When referrals are made, collaboration is essential to keep clients from falling through the cracks Treatment Planning and Confidentiality • Information, even within the agency, is restricted to need-to-know. • Treatment plans may have to be co-signed by a clinician who is already certified or licensed. Treatment Planning: Function • Action-oriented process that lays out a logical, goal-directed strategy for making positive changes • Establishes collaboration between client and counselor so they can prioritize mutually agreeable goals. Treatment Planning: Structure • Achievable goals are selected by assessing and prioritizing clients needs, taking into account • Level of impairment • Motivation • Real-world influences on needs • Treatment plans consider client • Needs • Readiness • Preferences and prior treatment history (what did and didn’t work) • Personal goals • Obstacles Treatment Planning: Structure • Defines • SMART Goals • Objectives • Anticipated type, duration and frequency of services • Who is responsible for what • Time table • Incorporates client input and participation in development • Have client prioritize presenting issues • Get input on goals and objectives • Both counselor and client sign the plan • The clinician may also facilitate and manage referrals (i.e. housing, legal, medical) Treatment Planning: Issues • At minimum, the plan is a flexible document that uses a stage-match process to address: • Identified Substance Use Disorders (SUDs) • Recovery support environment • Potential mental health conditions • Potential medical issues • Employment • Education • Spirituality • Social needs • Legal needs Elements of an Initial Treatment Plan • Done at admission (or within 24 hours) • Based on information from assessment and screening • Serves as the initial roadmap • Includes • Presenting problems • Preliminary goals • Type, frequency and duration of service • Signature and date of client and counselor w/credentials Elements of an Individualized Treatment Plan • Problem and problem description “Why are you here” • Strengths • Concrete, measurable goals • Objectives • Strategies w/ frequency and duration • Diagnosis • Signature of the client and counselor • Signature of clinical supervisor if required Treatment Planning: Ongoing and Review • Ongoing assessment and collaboration is used to regularly review the treatment plan and make necessary modifications • Review should be completed at minimum at major or key points in the clients treatment course • Admission or readmission • Transfer • Discharge • Major change in condition • After 12 months

AllCEUs started providing affordable CEUs and counseling continuing education, including online ceus and webinar based counseling ceus, in 2006 to help counselors licensed by their state board of professional counseling or state board of alcohol and drug abuse access affordable counselor continuing education, meet their continuing education requirements and enhance their addiction or mental health counseling practice. Since then, other companies have joined the marketplace to provide lpc continuing education including quantumunitsed, ce4less, Aspira aspirace, tzkseminars, i-counseling, accessceu, CEUbynet, pdresources. AllCEUs pioneered the model of offering unlimited CEU packages for a flat rate. We also were the first to offer live webinars each week for $5 per counseling webinar. We pride ourselves on having the largest catalog, with well over 200 multimedia, online counseling CEU courses. AllCEUs is an approved continuing education provider by the Connecticut Certification Board, The Florida Certification Board, FCB, The Alcohol and Drug Abuse Counseling Board of Georgia, ADACB-GA, NAADAC, the association for addiction professionals, the Texas Board of Social Work, The Texas Board of Professional Counseling, The Texas Board of Marriage and Family Therapy, California Consortium of Addiction Programs and Professionals, the Florida Board of Social Work, Mental Health Counseling and Marriage and Family Therapy and many other boards. It is important to note that, in most states, CEUs are NOT required to be NBCC approved, and most states accept ceus which are NOT from an NBCC approved continuing education provider or ACEP. For specific information about which other approval bodies your state accepts, you can visit our approvals page: https://cdn1.allceus.com/wp-content/uploads/2017/01/NewStateApprovalChart2017-1.pdf which provides a summary and links to the documents of the various state licensing boards for counselors, therapists and social workers. For mental health counselors, social workers and marriage and family therapists in Florida, AllCEUs reports your counseling CEUs to CE Broker. Whether you are a LCSW, MSW, LMFT, LMFT LMHC, LPC, LPCC, LCPC, CCMHC, MHC, CADC, LADC, CAP, LCDC, recovery coach, psychotherapist, pastoral counselor, addiction counselor, substance abuse counselor, recovery specialist, behavioral health technician needing mental health or addiction counseling CEUs online, or wanting to get certified as an addiction professional, AllCEUs has a variety of affordable online counseling CEUs, online addiction counselor certificate training tracks and face to face training options. Our unlimited CE packages provide professional counselor continuing education (CEUs) in addiction counseling, transdisciplinary foundations of addiction counseling, screening and assessment, diagnosis, family therapy, pharmacology, psychopharmacology, case management, crisis intervention, counseling tools, dialectical behavior therapy, mindfulness, acceptance and commitment therapy, ethics, supervision, working with adolescents, and many more.